Provider Demographics
NPI:1760133227
Name:HAN, DAI
Entity Type:Individual
Prefix:
First Name:DAI
Middle Name:
Last Name:HAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11028 LOWER AZUSA RD STE A
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-5406
Mailing Address - Country:US
Mailing Address - Phone:626-442-8135
Mailing Address - Fax:
Practice Address - Street 1:11028 LOWER AZUSA RD STE A
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-5406
Practice Address - Country:US
Practice Address - Phone:626-442-8135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-15
Last Update Date:2022-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85754183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist